Long-term cardiovascular risks and the impact of statin treatment on socioeconomic inequalities : a microsimulation model
© The Authors..
BACKGROUND: UK cardiovascular disease (CVD) incidence and mortality have declined in recent decades but socioeconomic inequalities persist.
AIM: To present a new CVD model, and project health outcomes and the impact of guideline-recommended statin treatment across quintiles of socioeconomic deprivation in the UK.
DESIGN AND SETTING: A lifetime microsimulation model was developed using 117 896 participants in 16 statin trials, 501 854 UK Biobank (UKB) participants, and quality-of-life data from national health surveys.
METHOD: A CVD microsimulation model was developed using risk equations for myocardial infarction, stroke, coronary revascularisation, cancer, and vascular and non-vascular death, estimated using trial data. The authors calibrated and further developed this model in the UKB cohort, including further characteristics and a diabetes risk equation, and validated the model in UKB and Whitehall II cohorts. The model was used to predict CVD incidence, life expectancy, quality-adjusted life years (QALYs), and the impact of UK guideline-recommended statin treatment across socioeconomic deprivation quintiles.
RESULTS: Age, sex, socioeconomic deprivation, smoking, hypertension, diabetes, and cardiovascular events were key CVD risk determinants. Model-predicted event rates corresponded well to observed rates across participant categories. The model projected strong gradients in remaining life expectancy, with 4-5-year (5-8 QALYs) gaps between the least and most socioeconomically deprived quintiles. Guideline-recommended statin treatment was projected to increase QALYs, with larger gains in quintiles of higher deprivation.
CONCLUSION: The study demonstrated the potential of guideline-recommended statin treatment to reduce socioeconomic inequalities. This CVD model is a novel resource for individualised long-term projections of health outcomes of CVD treatments.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2024 |
|---|---|
| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2024 |
|---|---|
| Enthalten in: |
The British journal of general practice : the journal of the Royal College of General Practitioners - (2024) vom: 19. Feb. |
| Sprache: |
Englisch |
|---|
| Links: |
|---|
| Themen: |
Cardiovascular disease |
|---|
| Anmerkungen: |
Date Revised 20.03.2024 published: Print-Electronic Citation Status Publisher |
|---|
| doi: |
10.3399/BJGP.2023.0198 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM368639088 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM368639088 | ||
| 003 | DE-627 | ||
| 005 | 20240320234300.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 240220s2024 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.3399/BJGP.2023.0198 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1337.xml |
| 035 | |a (DE-627)NLM368639088 | ||
| 035 | |a (NLM)38373851 | ||
| 035 | |a (PII)BJGP.2023.0198 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Wu, Runguo |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Long-term cardiovascular risks and the impact of statin treatment on socioeconomic inequalities |b a microsimulation model |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Revised 20.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a © The Authors. | ||
| 520 | |a BACKGROUND: UK cardiovascular disease (CVD) incidence and mortality have declined in recent decades but socioeconomic inequalities persist | ||
| 520 | |a AIM: To present a new CVD model, and project health outcomes and the impact of guideline-recommended statin treatment across quintiles of socioeconomic deprivation in the UK | ||
| 520 | |a DESIGN AND SETTING: A lifetime microsimulation model was developed using 117 896 participants in 16 statin trials, 501 854 UK Biobank (UKB) participants, and quality-of-life data from national health surveys | ||
| 520 | |a METHOD: A CVD microsimulation model was developed using risk equations for myocardial infarction, stroke, coronary revascularisation, cancer, and vascular and non-vascular death, estimated using trial data. The authors calibrated and further developed this model in the UKB cohort, including further characteristics and a diabetes risk equation, and validated the model in UKB and Whitehall II cohorts. The model was used to predict CVD incidence, life expectancy, quality-adjusted life years (QALYs), and the impact of UK guideline-recommended statin treatment across socioeconomic deprivation quintiles | ||
| 520 | |a RESULTS: Age, sex, socioeconomic deprivation, smoking, hypertension, diabetes, and cardiovascular events were key CVD risk determinants. Model-predicted event rates corresponded well to observed rates across participant categories. The model projected strong gradients in remaining life expectancy, with 4-5-year (5-8 QALYs) gaps between the least and most socioeconomically deprived quintiles. Guideline-recommended statin treatment was projected to increase QALYs, with larger gains in quintiles of higher deprivation | ||
| 520 | |a CONCLUSION: The study demonstrated the potential of guideline-recommended statin treatment to reduce socioeconomic inequalities. This CVD model is a novel resource for individualised long-term projections of health outcomes of CVD treatments | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Markov microsimulation model | |
| 650 | 4 | |a cardiovascular disease | |
| 650 | 4 | |a individual patient characteristics | |
| 650 | 4 | |a inequality | |
| 650 | 4 | |a quality-adjusted life years | |
| 650 | 4 | |a socioeconomic status | |
| 700 | 1 | |a Williams, Claire |e verfasserin |4 aut | |
| 700 | 1 | |a Zhou, Junwen |e verfasserin |4 aut | |
| 700 | 1 | |a Schlackow, Iryna |e verfasserin |4 aut | |
| 700 | 1 | |a Emberson, Jonathan |e verfasserin |4 aut | |
| 700 | 1 | |a Reith, Christina |e verfasserin |4 aut | |
| 700 | 1 | |a Keech, Anthony |e verfasserin |4 aut | |
| 700 | 1 | |a Robson, John |e verfasserin |4 aut | |
| 700 | 1 | |a Armitage, Jane |e verfasserin |4 aut | |
| 700 | 1 | |a Gray, Alastair |e verfasserin |4 aut | |
| 700 | 1 | |a Simes, John |e verfasserin |4 aut | |
| 700 | 1 | |a Baigent, Colin |e verfasserin |4 aut | |
| 700 | 1 | |a Mihaylova, Borislava |e verfasserin |4 aut | |
| 700 | 0 | |a CTT Collaboration secretariat |e verfasserin |4 aut | |
| 700 | 1 | |a Armitage, Jane |e verfasserin |4 aut | |
| 700 | 1 | |a Baigent, Colin |e verfasserin |4 aut | |
| 700 | 1 | |a Barnes, Elizabeth |e verfasserin |4 aut | |
| 700 | 1 | |a Blackwell, Lisa |e verfasserin |4 aut | |
| 700 | 1 | |a Collins, Rory |e verfasserin |4 aut | |
| 700 | 1 | |a Davies, Kelly |e verfasserin |4 aut | |
| 700 | 1 | |a Emberson, Jonathan |e verfasserin |4 aut | |
| 700 | 1 | |a Fulcher, Jordan |e verfasserin |4 aut | |
| 700 | 1 | |a Halls, Heather |e verfasserin |4 aut | |
| 700 | 1 | |a Herrington, William G |e verfasserin |4 aut | |
| 700 | 1 | |a Holland, Lisa |e verfasserin |4 aut | |
| 700 | 1 | |a Keech, Anthony |e verfasserin |4 aut | |
| 700 | 1 | |a Kirby, Adrienne |e verfasserin |4 aut | |
| 700 | 1 | |a Mihaylova, Borislava |e verfasserin |4 aut | |
| 700 | 1 | |a O'Connell, Rachel |e verfasserin |4 aut | |
| 700 | 1 | |a Preiss, David |e verfasserin |4 aut | |
| 700 | 1 | |a Reith, Christina |e verfasserin |4 aut | |
| 700 | 1 | |a Simes, John |e verfasserin |4 aut | |
| 700 | 1 | |a Wilson, Kate |e verfasserin |4 aut | |
| 700 | 0 | |a CTT Collaboration trialists: A to Z trial (phase Z) |e verfasserin |4 aut | |
| 700 | 1 | |a Blazing, Michael |e verfasserin |4 aut | |
| 700 | 1 | |a Braunwald, Eugene |e verfasserin |4 aut | |
| 700 | 1 | |a Lemos, James de |e verfasserin |4 aut | |
| 700 | 1 | |a Murphy, Sabina |e verfasserin |4 aut | |
| 700 | 1 | |a Pedersen, Terje R |e verfasserin |4 aut | |
| 700 | 1 | |a Pfeffer, Marc |e verfasserin |4 aut | |
| 700 | 1 | |a White, Harvey |e verfasserin |4 aut | |
| 700 | 1 | |a Wiviott, Stephen |e verfasserin |4 aut | |
| 700 | 0 | |a AFCAPS/TEXCAPS (AirForce/Texas Coronary Atherosclerosis Prevention Study) |e verfasserin |4 aut | |
| 700 | 1 | |a Clearfield, Michael |e verfasserin |4 aut | |
| 700 | 1 | |a Downs, John R |e verfasserin |4 aut | |
| 700 | 1 | |a Gotto, Antonio |c Jr |e verfasserin |4 aut | |
| 700 | 1 | |a Weis, Stephen |e verfasserin |4 aut | |
| 700 | 0 | |a ALERT (Assessment of Lescol in Renal Transplantation) |e verfasserin |4 aut | |
| 700 | 1 | |a Fellström, Bengt |e verfasserin |4 aut | |
| 700 | 1 | |a Holdaas, Hallvard |e verfasserin |4 aut | |
| 700 | 1 | |a Jardine, Alan |e verfasserin |4 aut | |
| 700 | 1 | |a Pedersen, Terje R |e verfasserin |4 aut | |
| 700 | 0 | |a ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) |e verfasserin |4 aut | |
| 700 | 1 | |a Gordon, David |e verfasserin |4 aut | |
| 700 | 1 | |a Davis, Barry |e verfasserin |4 aut | |
| 700 | 1 | |a Furberg, Curt |e verfasserin |4 aut | |
| 700 | 1 | |a Grimm, Richard |e verfasserin |4 aut | |
| 700 | 1 | |a Pressel, Sara |e verfasserin |4 aut | |
| 700 | 1 | |a Probstfield, Jeffrey L |e verfasserin |4 aut | |
| 700 | 1 | |a Rahman, Mahboob |e verfasserin |4 aut | |
| 700 | 1 | |a Simpson, Lara |e verfasserin |4 aut | |
| 700 | 0 | |a ALLIANCE (Aggressive Lipid-Lowering Initiation Abates New Cardiac Events) |e verfasserin |4 aut | |
| 700 | 1 | |a Koren, Michael |e verfasserin |4 aut | |
| 700 | 0 | |a ASCOT (Anglo-Scandinavian Cardiac Outcomes Trial) |e verfasserin |4 aut | |
| 700 | 1 | |a Dahlöf, Björn |e verfasserin |4 aut | |
| 700 | 1 | |a Gupta, Ajay |e verfasserin |4 aut | |
| 700 | 1 | |a Poulter, Neil |e verfasserin |4 aut | |
| 700 | 1 | |a Sever, Peter |e verfasserin |4 aut | |
| 700 | 1 | |a Wedel, Hans |e verfasserin |4 aut | |
| 700 | 0 | |a ASPEN (Atorvastatin Study for the Prevention of Coronary Heart Disease Endpoints in Non-Insulin Dependent Diabetes Mellitus) |e verfasserin |4 aut | |
| 700 | 1 | |a Knopp, Robert H |e verfasserin |4 aut | |
| 700 | 0 | |a AURORA (A study to evaluate the Use of Rosuvastatin in subjects On Regular haemodialysis: an Assessment of survival and cardiovascular events) |e verfasserin |4 aut | |
| 700 | 1 | |a Cobbe, Stuart |e verfasserin |4 aut | |
| 700 | 1 | |a Fellström, Bengt |e verfasserin |4 aut | |
| 700 | 1 | |a Holdaas, Hallvard |e verfasserin |4 aut | |
| 700 | 1 | |a Jardine, Alan |e verfasserin |4 aut | |
| 700 | 1 | |a Schmieder, Roland |e verfasserin |4 aut | |
| 700 | 1 | |a Zannad, Faiez |e verfasserin |4 aut | |
| 700 | 0 | |a CARDS (Collaborative Atorvastatin Diabetes Study) |e verfasserin |4 aut | |
| 700 | 1 | |a Betteridge, D John |e verfasserin |4 aut | |
| 700 | 1 | |a Colhoun, Helen M |e verfasserin |4 aut | |
| 700 | 1 | |a Durrington, Paul N |e verfasserin |4 aut | |
| 700 | 1 | |a Fuller, John |e verfasserin |4 aut | |
| 700 | 1 | |a Hitman, Graham A |e verfasserin |4 aut | |
| 700 | 1 | |a Neil, Andrew |e verfasserin |4 aut | |
| 700 | 0 | |a CARE (Cholesterol And Recurrent Events Study) |e verfasserin |4 aut | |
| 700 | 1 | |a Braunwald, Eugene |e verfasserin |4 aut | |
| 700 | 1 | |a Davis, Barry |e verfasserin |4 aut | |
| 700 | 1 | |a Hawkins, C Morton |e verfasserin |4 aut | |
| 700 | 1 | |a Moyé, Lemuel |e verfasserin |4 aut | |
| 700 | 1 | |a Pfeffer, Marc |e verfasserin |4 aut | |
| 700 | 1 | |a Sacks, Frank |e verfasserin |4 aut | |
| 700 | 0 | |a CORONA (Controlled Rosuvastatin Multinational Trial in Heart Failure) |e verfasserin |4 aut | |
| 700 | 1 | |a Kjekshus, John |e verfasserin |4 aut | |
| 700 | 1 | |a Wedel, Hans |e verfasserin |4 aut | |
| 700 | 1 | |a Wikstrand, John |e verfasserin |4 aut | |
| 700 | 0 | |a 4D (Die Deutsche Diabetes Dialyse Studie) |e verfasserin |4 aut | |
| 700 | 1 | |a Wanner, Christoph |e verfasserin |4 aut | |
| 700 | 1 | |a Krane, Vera |e verfasserin |4 aut | |
| 700 | 0 | |a GISSI (Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto miocardico) Heart Failure and Prevention trials |e verfasserin |4 aut | |
| 700 | 0 | |a HOPE-3 |e verfasserin |4 aut | |
| 700 | 0 | |a HPS (Heart Protection Study) |e verfasserin |4 aut | |
| 700 | 0 | |a IDEAL (Incremental Decrease in Endpoints through Aggressive Lipid-lowering) |e verfasserin |4 aut | |
| 700 | 0 | |a JUPITER (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) |e verfasserin |4 aut | |
| 700 | 0 | |a LIPID (Long-term Intervention with Pravastatin in Ischaemic Disease) |e verfasserin |4 aut | |
| 700 | 0 | |a LIPS (Lescol Intervention Prevention Study) |e verfasserin |4 aut | |
| 700 | 0 | |a Post-CABG (Post-Coronary Artery Bypass Graft Study) |e verfasserin |4 aut | |
| 700 | 0 | |a PROSPER (Prospective Study of Pravastatin in the Elderly at Risk) |e verfasserin |4 aut | |
| 700 | 0 | |a PROVE-IT (Pravastatin or Atorvastatin Evaluation and Infection Therapy) |e verfasserin |4 aut | |
| 700 | 0 | |a SEARCH (Study of Effectiveness of Additional Reductions in Cholesterol and Homocysteine) |e verfasserin |4 aut | |
| 700 | 0 | |a SPARCL (Stroke Prevention by Aggressive Reduction in Cholesterol Levels) |e verfasserin |4 aut | |
| 700 | 0 | |a 4S (Scandinavian Simvastatin Survival Study) |e verfasserin |4 aut | |
| 700 | 0 | |a TNT (Treating to New Targets) |e verfasserin |4 aut | |
| 700 | 0 | |a WOSCOPS (West of Scotland Coronary Prevention Study) |e verfasserin |4 aut | |
| 700 | 0 | |a Other CTT Collaboration members |e verfasserin |4 aut | |
| 700 | 0 | |a et al |4 oth | |
| 773 | 0 | 8 | |i Enthalten in |t The British journal of general practice : the journal of the Royal College of General Practitioners |d 1996 |g (2024) vom: 19. Feb. |w (DE-627)NLM012664286 |x 1478-5242 |7 nnns |
| 773 | 1 | 8 | |g year:2024 |g day:19 |g month:02 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.3399/BJGP.2023.0198 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |j 2024 |b 19 |c 02 | ||